The Experts below are selected from a list of 1782 Experts worldwide ranked by ideXlab platform
R. Onders - One of the best experts on this subject based on the ideXlab platform.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, Margret OddsdottirAbstract:Background Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, John Yee, Margret OddsdottirAbstract:Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients. In prospective Food and Drug Administration (FDA) trials, patients underwent laparoscopic Diaphragm motor point mapping with intramuscular electrode implantation. Stimulation of the electrodes ensued to condition and strengthen the Diaphragm. From March of 2000 to September of 2007, a total of 88 patients (50 SCI and 38 ALS) were implanted with DPS at five sites. Patient age ranged from 18 to 74 years. Time from SCI to implantation ranged from 3 months to 27 years. In 87 patients the Diaphragm motor point was mapped with successful implantation of electrodes with the only failure the second SCI patient who had a false-positive phrenic nerve study. Patients with ALS had much weaker Diaphragms identified surgically, requiring trains of stimulation during mapping to identify the motor point at times. There was no perioperative mortality even in ALS patients with forced vital capacity (FVC) below 50% predicted. There was no cardiac involvement from Diaphragm pacing even when analyzed in ten patients who had pre-existing cardiac pacemakers. No infections occurred even with simultaneous gastrostomy tube placements for ALS patients. In the SCI patients 96% were able to use DPS to provide ventilation replacing their mechanical ventilators and in the ALS studies patients have been able to delay the need for mechanical ventilation up to 24 months. This multicenter experience has shown that laparoscopic Diaphragm motor point mapping, electrode implantation, and pacing can be safely performed both in SCI and in ALS. In SCI patients it allows freedom from ventilator and in ALS patients it delays the need for ventilators, increasing survival.
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phrenic nerve conduction studies in spinal cord injury applications for Diaphragmatic pacing
Muscle & Nerve, 2008Co-Authors: Amer Alshekhlee, R. Onders, Maryjo Elmo, Tanvir U Syed, Bashar KatirjiAbstract:The Diaphragm pacing system (DPS) is a minimally invasive alternative to mechanical ventilation in patients with quadriplegia due to cervical myelopathy primarily caused by high cervical spinal cord injury. We evaluated 36 patients, 29 of whom had traumatic spinal cord injury, two who had a history of remote meningitis and demyelinating disease, and five who had cervical myelopathies of unknown etiology. Phrenic nerve conduction studies were performed with simultaneous fluoroscopic observation of Diaphragm excursion to assess Diaphragm viability. In the preoperative evaluation, Diaphragm compound muscle action potentials (CMAPs) were recorded only when the Diaphragm moved on fluoroscopy with ipsilateral stimulation. Twenty-six patients who were determined to have a viable Diaphragm underwent DPS. Following DPS the primary outcome was the time (hours per day) that patients were able to pace and stay off the ventilator. Of 26 implanted patients, 96% (25 patients) were able to pace and tolerate being off the ventilator for more than 4 h per day. This study demonstrates that the presence of a Diaphragm CMAP is associated with Diaphragm Movement observed by fluoroscopy in cervical myelopathy. In addition, DPS can help patients with cervical spinal cord injury to breathe unassisted by a ventilator.
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mapping the phrenic nerve motor point the key to a successful laparoscopic Diaphragm pacing system in the first human series
Surgery, 2004Co-Authors: R. Onders, Anthony R Ignagni, Anthony F. Dimarco, Harish Aiyar, Thomas J MortimerAbstract:Background For patients with high spinal cord injury and chronic respiratory insufficiency, electrically induced Diaphragm pacing is an alternative to long-term positive pressure ventilation. The goal of this study was to laparoscopically assess the phrenic nerve motor point of the Diaphragm and then implant electrodes to produce chronic negative pressure ventilation. Methods Patients undergoing elective laparoscopic procedures (volunteer patient group) underwent a series of electrical stimuli (2 to 24 mA at 100-microsecond pulse widths) with a mapping probe to identify the motor point through qualitative visualization of Diaphragm motion and quantitative measurement of the abdominal pressure to assess the strength of the contraction. After Food and Drug Administration and Institutional Review Board approval, tetraplegic patients (spinal cord injured patient group) who were ventilator dependent underwent mapping and implantation of electrodes for pacing in both Diaphragms. Results In the volunteer group, 28 patients underwent 3 to 50 stimulations per Diaphragm to identify the motor points. Throughout this series the surgical tools and software were improved to allow rapid motor point location with a grid-mapping algorithm. In the spinal cord injured group, 5 of 6 patients had electrodes successfully implanted at the motor point to produce adequate tidal volumes. The one failure caused a change in our inclusion criteria to include fluoroscopic confirmation of Diaphragm Movement during surface nerve stimulation. Three patients are completely free of the ventilator, and the other 2 are progressively increasing their time off the ventilator with conditioning. Conclusions Mapping and implantation of the electrodes can be done laparoscopically, providing for a low-risk, cost-effective, outpatient, Diaphragm pacing system that will support the respiratory needs of patients.
Margret Oddsdottir - One of the best experts on this subject based on the ideXlab platform.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, Margret OddsdottirAbstract:Background Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, John Yee, Margret OddsdottirAbstract:Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients. In prospective Food and Drug Administration (FDA) trials, patients underwent laparoscopic Diaphragm motor point mapping with intramuscular electrode implantation. Stimulation of the electrodes ensued to condition and strengthen the Diaphragm. From March of 2000 to September of 2007, a total of 88 patients (50 SCI and 38 ALS) were implanted with DPS at five sites. Patient age ranged from 18 to 74 years. Time from SCI to implantation ranged from 3 months to 27 years. In 87 patients the Diaphragm motor point was mapped with successful implantation of electrodes with the only failure the second SCI patient who had a false-positive phrenic nerve study. Patients with ALS had much weaker Diaphragms identified surgically, requiring trains of stimulation during mapping to identify the motor point at times. There was no perioperative mortality even in ALS patients with forced vital capacity (FVC) below 50% predicted. There was no cardiac involvement from Diaphragm pacing even when analyzed in ten patients who had pre-existing cardiac pacemakers. No infections occurred even with simultaneous gastrostomy tube placements for ALS patients. In the SCI patients 96% were able to use DPS to provide ventilation replacing their mechanical ventilators and in the ALS studies patients have been able to delay the need for mechanical ventilation up to 24 months. This multicenter experience has shown that laparoscopic Diaphragm motor point mapping, electrode implantation, and pacing can be safely performed both in SCI and in ALS. In SCI patients it allows freedom from ventilator and in ALS patients it delays the need for ventilators, increasing survival.
Maryjo Elmo - One of the best experts on this subject based on the ideXlab platform.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, Margret OddsdottirAbstract:Background Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients.
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complete worldwide operative experience in laparoscopic Diaphragm pacing results and differences in spinal cord injured patients and amyotrophic lateral sclerosis patients
Surgical Endoscopy and Other Interventional Techniques, 2009Co-Authors: R. Onders, Saeid Khansarinia, Maryjo Elmo, Brock Bowman, Jeremy Road, Barbara L Bass, Brian J Dunkin, Pall Ingvarsson, John Yee, Margret OddsdottirAbstract:Diaphragm Movement is essential for adequate ventilation, and when the Diaphragm is adversely affected patients face lifelong positive-pressure mechanical ventilation or death. This report summarizes the complete worldwide multicenter experience with Diaphragm pacing stimulation (DPS) to maintain and provide Diaphragm function in ventilator-dependent spinal cord injury (SCI) patients and respiratory-compromised patients with amyotrophic lateral sclerosis (ALS). It will highlight the surgical experiences and the differences in Diaphragm function in these two groups of patients. In prospective Food and Drug Administration (FDA) trials, patients underwent laparoscopic Diaphragm motor point mapping with intramuscular electrode implantation. Stimulation of the electrodes ensued to condition and strengthen the Diaphragm. From March of 2000 to September of 2007, a total of 88 patients (50 SCI and 38 ALS) were implanted with DPS at five sites. Patient age ranged from 18 to 74 years. Time from SCI to implantation ranged from 3 months to 27 years. In 87 patients the Diaphragm motor point was mapped with successful implantation of electrodes with the only failure the second SCI patient who had a false-positive phrenic nerve study. Patients with ALS had much weaker Diaphragms identified surgically, requiring trains of stimulation during mapping to identify the motor point at times. There was no perioperative mortality even in ALS patients with forced vital capacity (FVC) below 50% predicted. There was no cardiac involvement from Diaphragm pacing even when analyzed in ten patients who had pre-existing cardiac pacemakers. No infections occurred even with simultaneous gastrostomy tube placements for ALS patients. In the SCI patients 96% were able to use DPS to provide ventilation replacing their mechanical ventilators and in the ALS studies patients have been able to delay the need for mechanical ventilation up to 24 months. This multicenter experience has shown that laparoscopic Diaphragm motor point mapping, electrode implantation, and pacing can be safely performed both in SCI and in ALS. In SCI patients it allows freedom from ventilator and in ALS patients it delays the need for ventilators, increasing survival.
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phrenic nerve conduction studies in spinal cord injury applications for Diaphragmatic pacing
Muscle & Nerve, 2008Co-Authors: Amer Alshekhlee, R. Onders, Maryjo Elmo, Tanvir U Syed, Bashar KatirjiAbstract:The Diaphragm pacing system (DPS) is a minimally invasive alternative to mechanical ventilation in patients with quadriplegia due to cervical myelopathy primarily caused by high cervical spinal cord injury. We evaluated 36 patients, 29 of whom had traumatic spinal cord injury, two who had a history of remote meningitis and demyelinating disease, and five who had cervical myelopathies of unknown etiology. Phrenic nerve conduction studies were performed with simultaneous fluoroscopic observation of Diaphragm excursion to assess Diaphragm viability. In the preoperative evaluation, Diaphragm compound muscle action potentials (CMAPs) were recorded only when the Diaphragm moved on fluoroscopy with ipsilateral stimulation. Twenty-six patients who were determined to have a viable Diaphragm underwent DPS. Following DPS the primary outcome was the time (hours per day) that patients were able to pace and stay off the ventilator. Of 26 implanted patients, 96% (25 patients) were able to pace and tolerate being off the ventilator for more than 4 h per day. This study demonstrates that the presence of a Diaphragm CMAP is associated with Diaphragm Movement observed by fluoroscopy in cervical myelopathy. In addition, DPS can help patients with cervical spinal cord injury to breathe unassisted by a ventilator.
Ian B. Stewart - One of the best experts on this subject based on the ideXlab platform.
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in patients with unilateral pleural effusion restricted lung inflation is the principal predictor of increased dyspnoea
PLOS ONE, 2018Co-Authors: Luke Albert Garske, Kuhan Kunarajah, Lewis Adams, P V Zimmerman, Ian B. StewartAbstract:Background and objectiveThe mechanism of dyspnoea associated with pleural effusion is uncertain. A cohort of patients requiring thoracoscopy for unilateral exudative effusion were investigated for associations between dyspnoea and suggested predictors: impaired ipsilateral Diaphragm Movement, effusion volume and restricted lung inflation.MethodsBaseline Dyspnoea Index, respiratory function, and ultrasound assessment of ipsilateral Diaphragm Movement were assessed prior to thoracoscopy, when effusion volume was measured. Transitional Dyspnoea Index (change from baseline) was assessed 4 and 8 weeks after thoracoscopy. Pearson product moment assessed bivariate correlations and a general linear model examined how well total lung capacity (measuring restricted lung inflation), effusion volume and impaired Diaphragm Movement predicted Baseline Dyspnoea Index. Un-paired t tests compared the groups with normal and impaired Diaphragm Movement.Results19 patients were studied (14 malignant etiology). Total lung capacity was associated with Baseline Dyspnoea Index (r = 0.68, P = 0.003). Effusion volume (r = -0.138, P = 0.60) and Diaphragm Movement (P = 0.09) were not associated with Baseline Dyspnoea Index. Effusion volume was larger with impaired Diaphragm Movement compared to normal Diaphragm Movement (2.16 +/- SD 0.95 vs.1.16 +/- 0.92 L, P = 0.009). Total lung capacity was lower with impaired Diaphragm Movement compared to normal Diaphragm Movement (65.4 +/- 10.3 vs 78.2 +/- 8.6% predicted, P = 0.011). The optimal general linear model to predict Baseline Dyspnoea Index used total lung capacity alone (adjusted R-2 = 0.42, P = 0.003). In nine participants with controlled effusion, baseline effusion volume (r = 0.775, P = 0.014) and total lung capacity (r = -0.690, P = 0.040) were associated with Transitional Dyspnoea Index.ConclusionsRestricted lung inflation was the principal predictor of increased dyspnoea prior to thoracoscopic drainage of effusion, with no independent additional association with either effusion volume or impaired ipsilateral Diaphragm Movement. Restricted lung inflation may be an important determinant of the dyspnoea associated with pleural effusion.
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Comparison of baseline respiratory function between participants with normal and impaired Diaphragm Movement.
2018Co-Authors: Luke Albert Garske, Kuhan Kunarajah, Lewis Adams, Paul V. Zimmerman, Ian B. StewartAbstract:Comparison of baseline respiratory function between participants with normal and impaired Diaphragm Movement.
Luke Albert Garske - One of the best experts on this subject based on the ideXlab platform.
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in patients with unilateral pleural effusion restricted lung inflation is the principal predictor of increased dyspnoea
PLOS ONE, 2018Co-Authors: Luke Albert Garske, Kuhan Kunarajah, Lewis Adams, P V Zimmerman, Ian B. StewartAbstract:Background and objectiveThe mechanism of dyspnoea associated with pleural effusion is uncertain. A cohort of patients requiring thoracoscopy for unilateral exudative effusion were investigated for associations between dyspnoea and suggested predictors: impaired ipsilateral Diaphragm Movement, effusion volume and restricted lung inflation.MethodsBaseline Dyspnoea Index, respiratory function, and ultrasound assessment of ipsilateral Diaphragm Movement were assessed prior to thoracoscopy, when effusion volume was measured. Transitional Dyspnoea Index (change from baseline) was assessed 4 and 8 weeks after thoracoscopy. Pearson product moment assessed bivariate correlations and a general linear model examined how well total lung capacity (measuring restricted lung inflation), effusion volume and impaired Diaphragm Movement predicted Baseline Dyspnoea Index. Un-paired t tests compared the groups with normal and impaired Diaphragm Movement.Results19 patients were studied (14 malignant etiology). Total lung capacity was associated with Baseline Dyspnoea Index (r = 0.68, P = 0.003). Effusion volume (r = -0.138, P = 0.60) and Diaphragm Movement (P = 0.09) were not associated with Baseline Dyspnoea Index. Effusion volume was larger with impaired Diaphragm Movement compared to normal Diaphragm Movement (2.16 +/- SD 0.95 vs.1.16 +/- 0.92 L, P = 0.009). Total lung capacity was lower with impaired Diaphragm Movement compared to normal Diaphragm Movement (65.4 +/- 10.3 vs 78.2 +/- 8.6% predicted, P = 0.011). The optimal general linear model to predict Baseline Dyspnoea Index used total lung capacity alone (adjusted R-2 = 0.42, P = 0.003). In nine participants with controlled effusion, baseline effusion volume (r = 0.775, P = 0.014) and total lung capacity (r = -0.690, P = 0.040) were associated with Transitional Dyspnoea Index.ConclusionsRestricted lung inflation was the principal predictor of increased dyspnoea prior to thoracoscopic drainage of effusion, with no independent additional association with either effusion volume or impaired ipsilateral Diaphragm Movement. Restricted lung inflation may be an important determinant of the dyspnoea associated with pleural effusion.
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Comparison of baseline respiratory function between participants with normal and impaired Diaphragm Movement.
2018Co-Authors: Luke Albert Garske, Kuhan Kunarajah, Lewis Adams, Paul V. Zimmerman, Ian B. StewartAbstract:Comparison of baseline respiratory function between participants with normal and impaired Diaphragm Movement.